Student insights on strengthening health systems

Cab Rides and Landslides in Global Health Research

I’m on the back of a motorcycle, debriefing with Anjali, the woman conducting my focus groups in Hindi. We’re in a small town in the Himalayas. It’s monsoon season and it’s pouring rain. We weave through traffic, pedestrians, and stalls as I start to record her voice. Rakesh drives and we shout over the noise of the bike, discussing how it went and how we can improve and probe further next time. As we reach the base of the hills, the motorbike roars loudly and the three of us squeeze together as we climb roads too steep for cars. We dismount as we reach the next location, holding hot samosas and bottles of Coke in our hands for the women. I cut the recording.

Global health work sounds sexy. It isn’t. This is a story about a girl and the hazards of fieldwork.

Girl starts her Global Health MSc and makes a plan to conduct primary research on women’s mental health. She contacts a local Non-Government Organization (NGO) in the Himalayas, starts learning Hindi, and gets ready to leave.

Prior to her departure she’s very anxious. Some people tell her it’s unsafe for a girl to go alone. They remind her of all the sexual assault stories the media has plastered across the web. Others say it’s fine, she’ll be okay. She wants to check it out for herself. She’s traveled to many other parts of the world alone.

The flight lands and things are fine. Some lack of sleep and jetlag but that’s normal. A few health problems arise and she makes some frantic phone calls back home for medical support. A little more anxious, but okay.

She takes a flight North to the foothills of the Himalayas and her new home for fieldwork. The taxi groans as it climbs the narrow mountainous roads. She is dropped off and she settles in, tucking in for some momo dumplings.

Walking around the town, men stare at her, call to her, and chase after her on their motorbikes. She’s overwhelmed and completely alone.

She registers at Hindi school and starts to get to know the community by making field visits and meeting community health workers. Hindi lessons in the morning, field visits in the afternoon, and some qualitative textbook reading and a movie before bed. More aggression from local men, more anxiety.

Sitting in cabs, alone in the mountains, she’s tense. With every cab ride she’s never sure where they are going to take her. The big grin on his face. Is she safe?

Trying to escape, she takes off traveling for a week. Temples, hotels, and a train ride through the mountains at night. The train winds its way around the mountain, tracks at the edge. Windows as wide as doors, she holds on tight and looks down at the tiny towns and roads below, her adrenaline high.

Back at work, she starts the focus groups. She finds a beautiful new home to move to. A warm Ethiopian woman owns the place and they quickly become friends. The rain starts to fall, marking the beginning of monsoon season. They huddle inside while making chai telling their life stories and laughing.

Then the landslides start. Cars are going off the road and people are falling to their deaths. And yet, she still has to get into taxis and drive down the mountain roads to finish her study. Is the car in good shape? Unknown. Is the driver going to take advantage of her? Unknown. Will she make it back safely to Canada? She listens to podcasts, escaping to the world of ‘This American Life’.

Her research goes remarkably well. Eighteen interviews and focus group discussions later the results look very promising. This is important research.

For four days the rain doesn’t stop. It’s pouring. Everything is wet. Her clothes. Her hair. Her body. The spiders come inside. Big, the size of your palm and fast as a bullet. As they start to find refuge in her home, she masters the art of throwing large objects at them.

One day, the clouds break and the rain stops. She can see all the way down across the plains to the giant foothills beyond. It’s a gorgeous day. The sun pops its head out. Her clothes dry and her body warms. As she walks down the mountain, there’s hope. Everything will be alright.

Global health fieldwork can be rewarding but also challenging. The risks to personal safety must be considered, as they can be under-appreciated when caught up trying to make an impact on the global health research landscape.

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